A program to prevent and control the spread of serious infections fails to meet "any modern staffing recommendations," found an internationally recognized expert called in to look at unusually high levels of C. difficile at Burnaby General Hospital in the Vancouver suburb.

VICTORIA — A program to prevent and control the spread of serious infections fails to meet "any modern staffing recommendations," found an internationally recognized expert called in to look at unusually high levels of C. difficile at Burnaby General Hospital in the Vancouver suburb.

"The number of trained infection control practitioners belonging to the (Fraser Health) program is less than half what would be considered acceptable by current standards," said Dr. Michael Gardam in a report completed Feb. 6.

"This directly impacts the control of organisms such as C. difficile as the (infection prevention and control) resources appear overwhelmed," he added.

"Burnaby Hospital and Royal Columbian Hospital currently have a total of four (infection control practitioners) who provide services for roughly 800 in-patient beds."

Fraser Health asked Gardam last November to look at the high levels of C. difficile at both Burnaby General and Royal Columbian hospitals, and to make recommendations on how the virus could better be controlled.

Gardam's report, which contained 13 recommendations, was released by Fraser Health on Thursday, one day after a harsh rebuke by doctors at Burnaby Hospital was made public. In a strongly worded January letter to the head of Fraser Health — which the provincial New Democratic Party obtained and released on Wednesday — the doctors expressed alarm over the fact that 84 people with C. difficile had died at Burnaby Hospital from 2009 to mid-2011.

Gardam is the director of infection prevention and control at Toronto's University Health Network and Women's College Hospital. In a news release accompanying his report, Fraser Health identified him as "an international authority on infection prevention and control practices."

On Thursday, officials at Fraser Health said they were working to immediately implement 10 of the recommendations, but not the other three.

One of those not getting an immediate response was the staffing deficiency Gardam identified in the regional infection prevention and control program.

"This one is one of the ones that (is) still under discussion," Fraser Health vice-president Dr. Andrew Webb said in an interview Thursday.

"We know we have low numbers compared to other health authorities or hospitals, but we also rely on the fact that infection prevention control is the responsibility of everyone who is touching patients," he said.

"One of the reasons we're not sure where to go with this is we've got to work out clearly whether we just put another 12 (infection control) practitioners in place, would that really make a difference?" he said, explaining that might dissuade others on staff from taking individual responsibility for the issue.

"We're not sure of that, and that's why we haven't raced to implement that."

Not good enough, said Health Minister Mike de Jong.

"I think when you call an expert in, you'd be well advised to follow the advice of that expert. That is what I have communicated to Fraser Health," he said Thursday afternoon.

De Jong said he has asked Dr. Doug Cochrane of the B.C. Patient Safety and Quality Council to work directly with Fraser Health on implementing all 13 recommendations.

"When you've got a facility that is showing improvement, but is still out of step with what we would deem acceptable levels of this infection, and you have recommendations from an expert about what is necessary to address that, I believe you have to follow those recommendations," he said.

New Democratic Party health critic Mike Farnworth said he agrees all 13 recommendations need to be implemented, especially the one relating to proper staffing levels for infection control.

"I think it's just unconscionable, appalling that one of the key findings is that we don't by any definition meet modern staffing standards," he said.

"I think that's outrageous and I think the government needs to be prepared to put resources in place to do that."

Farnworth said he is concerned about the obvious lack of communication between Fraser Health and de Jong regarding the recommendations.

"This just illustrates there's a disconnect between what's happening in the health authority and what the minister thinks is or isn't happening," he said, noting de Jong didn't know the letter from Burnaby doctors even existed until the NDP raised it in question period Wednesday.

While the doctors' letter said only that there had been 84 deaths associated with C. difficile — not caused by it — de Jong challenged a growing public perception that the deaths were attributed to the disease.

"To suggest that 84 individuals have died because of C. difficile is incorrect," de Jong told the legislature Thursday, adding the claim "unnecessarily causes concern."

In an interview, de Jong said he does not have a number for deaths caused by C. difficile in the 2 1/2-year period, but said that in 2010-11, there were 13 cases at Burnaby Hospital where C. difficile is believed to have contributed to a patient's death.

Of those 13 cases, officials at Fraser Health added, eight involved patients over the age of 80, and all had other complicating medical conditions.

Also on Thursday, representatives of the Hospital Employees' Union — which represents 1,200 workers employed by Fraser Health at the hospital and an additional 70 cleaning staff employed by Aramark — raised concerns about the validity of cleaning audits at the hospital. They noted Burnaby Hospital surpassed all cleaning standards in audits conducted in 2009 through mid-2011.

"Right now, the quality of hospital cleaning is based on visual appearances only," HEU secretary-business manager Bonnie Pearson said in a news release.

"But there are a range of factors involved in ensuring that our hospitals are clean and safe including enough cleaning staff, with the right tools and training, to deliver this critical health service."

De Jong brushed aside the criticism, saying the province specifically monitors for infections like C. difficile using different measures than those contained in cleaning audits.

"Infection relates to microorganisms and that's why the monitoring that has taken place around C. difficile is so important because it goes beyond other basic monitoring from cleanliness," he said.

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